Postpartum Contraception use by Urban/Rural Status: An Analysis of the Michigan Pregnancy Risk Assessment Monitoring System Data
Starr, K.A.; Martins, S.L.; Watson, S.; Gilliam, M.L.
Women's Health Issues Official Publication of the Jacobs Institute of Women's Health 25(6): 622-627
2015
ISSN/ISBN: 1878-4321 PMID: 26253826 DOI: 10.1016/j.whi.2015.06.014Document Number: 638317
We sought to examine rural/urban differences in postpartum contraceptive use, which are underexplored in the literature. We analyzed phase 5 (2004-2008) of the Michigan Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Using Rural-Urban Commuting Area codes and weighted multinomial logistic regression, we examined the association between self-reported postpartum contraceptive method and rural/urban residence among postpartum women not desiring pregnancy (n = 6,468). Postpartum (mean, 16.5 weeks after delivery), 14.4% of respondents were using sterilization, 6.7% long-acting reversible contraception (LARC), 37.3% moderately effective hormonal methods, 38.4% less effective methods or no method, and 3.2% abstinence. Multivariable analysis yielded sporadic geographic patterns. Odds of method use varied significantly by age, parity, body mass index, and breastfeeding status. Not discussing contraception with a prenatal healthcare provider decreased odds of postpartum LARC use (odds ratio, 0.52; 95% CI, 0.36-0.75). Number of prenatal visits and weeks since delivery were not associated with postpartum contraception method. We did not observe strong variation in postpartum contraceptive use based on geography. Low uptake of highly effective contraception across rural and urban areas suggests a need for education and outreach regarding these methods.
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